Ask the doctor: Will my shingles pain ever go away?

Ask the doctor: Will my shingles pain ever go away?

For the past three years, I have suffered from shingles pain. It affects my shoulders and head, and at times is very painful. Some time ago, I was told there was no cure or treatment for this condition. Is this still the case?

John Ludlow, Surrey.

The most common treatments for shingles pain are tricyclic antidepressants and anti-epileptic drugs

This can be a very disheartening condition, but don’t lose hope — there are treatment options available to you.

Shingles triggers a red, painful rash on one side of the body, usually the chest and abdomen, though any area can be affected.

The condition starts with a tingling or burning sensation that progresses quickly to a painful, red rash, which erupts into itchy blisters.

The whole episode usually lasts for between two to four weeks and is triggered by the same virus that causes chicken pox — the herpes varicella-zoster virus.

Everyone who develops shingles would have suffered from chicken pox in childhood — the virus is then locked away by your immune system in nerve tissue.

However, when the immune system becomes weakened in adulthood, perhaps through another illness or simply as a consequence of age, the virus can escape its long-term imprisonment and triggers the symptoms.

This happens to one in four of us over the age of 50 (it’s less common in younger people). Luckily, it usually strikes just once.

The problem is that even after the rash has cleared up (though often with some scarring of the site), up to one in five patients experiences pain in the area for months, even years, causing significant suffering.

Called postherpetic neuralgia, it is caused by damage to the nerves. The older you are at the time of the attack (and the greater the severity of the original attack), the more likely this is to happen.

This long-term pain is associated with low mood, impaired sleep and loss of appetite.

All pain clinics and pain control specialists will have experience of treating postherpetic neuralgia.

The most common treatments are tricyclic antidepressants and anti-epileptic drugs such as gabapentin or pregabalin.

CONTACT DR SCURR

To
contact Dr Scurr with a health query, write to him at Good Health Daily
Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk —
including contact details.

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

In my experience, the tricyclic antidepressants are the most effective — these are prescribed in much smaller doses for shingles pain than the amount needed for treating depressive illness.

And they work not as antidepressants, but rather inhibit the pain signals from damaged nerve tissue. The most commonly used form is amitriptyline.

If the response is good then the treatment must be continued for some months, occasionally years, to ensure a permanent relief from the postherpetic neuralgia. The main side-effects are sleepiness, dry mouth, constipation and even difficulty in reading small print.

Such side-effects do reduce as time passes and are far less disruptive than the pain.

I would advise you to seek referral to a pain clinic. If this is not available in your area, then a neurologist will be familiar with the approach and your GP can make the relevant referral.

There is no reason why this suffering should continue.

On a final note: a shingles jab becomes available on the NHS in September (initially it will be rolled out to those aged 70 and 79, and then expanded so this whole age group is covered).

The jab is licensed for those over the age of 50, so you can get it privately. It prevents shingles from occurring — or if it does occur, it will be a minor attack with an almost zero incidence of postherpetic neuralgia. Very good news indeed.

Recently I was diagnosed with the eye condition Fuchs’ corneal dystrophy. I am 72 and both eyes are affected. I haven’t been given much information about the condition — could you provide me with any details?

P. Corduss, Melton Mowbray, Leics.

What a worry it must be to feel so unsupported when you have a condition that affects your sight.

Unfortunately, your condition is incurable, but the good news is that it does progress slowly — in fact, some cases do not get worse at all, and there are treatment options available.

The disease affects the cornea, the clear surface at the front of the eye that covers the iris and pupil.

The curvature of this layer focuses the light onto the retina at the back of the eye and hence is crucial for the formation of an image. In short, the cornea is responsible for most of our vision.

It contains no blood vessels, though it does have highly sensitive nerve endings, which is why the tiniest bit of grit in your eye can prove so painful.

The cornea is a complex structure with five layers; while the cause of Fuchs is not clear (though genetics may play a role), it seems to cause water to build up in the two inner-most layers.

As the water content rises, the cornea becomes increasingly cloudy, and the vision blurred.

The disease, which was first described by Austrian ophthalmologist Ernst Fuchs in 1906, is almost always seen in people over the age of 50.

At your stage, the key issue is what can be done to conserve and make the best of what vision you still have.

The simplest treatment is to apply a saline eye drop (you’ll need one
that contains 5 per cent sodium chloride, which can be bought at a
pharmacy). This dehydrates the corneal tissue, helping to clear the
excess water.

You can also use a hairdryer at arm’s length to dehydrate the front of the eye, on a regular thrice-daily regimen.

Beyond these options the only other treatment is corneal
transplantation. This involves replacing your corneal tissue with a
donor cornea, which can be done as day surgery.

Full recovery can take between one and two years, though in about one in five cases the body rejects the donor cornea.

My feeling is that you should be examined on an annual basis to follow
your progress — it may be reassuring to document the extent of change
and receive advice about any future prospects for treatment.

As so often, a few spoken words are worth a thousand written: good
communication is everything and this has been lacking for you.

By the way...

GPs have failed if patients won’t take pills

When GPs prescribe a medicine for a patient to take long term, it’s not something we do lightly. There is a multitude of factors to be weighed up — risks versus benefits, a potential clash with a drug the patient is already taking, and the cost.

We have training and official guidance on what we prescribe (as well as a safety net computer system that highlights dangerous medicine interactions).

Doctors need to explain with sufficient care to patients both the benefits and the risks of medication

Yet to some patients it may appear that a decision of considerable magnitude is made quickly and we are just adhering to some sort of party line. So they don’t bother taking their pills.

Just last week, a patient asked me for a blood test — I assumed she wanted to check her cholesterol to see if the statin she was prescribed some months ago was achieving the desired result. In fact, she was feeling exhausted and wanted to know if she was anaemic.

I asked about the statin and she firmly replied she had not taken it because friends said it has side-effects.

It is difficult not to bristle, but you have to realise such a reaction indicates a failure in explaining with sufficient care about the balance of risks and benefits.

Public mythology is a powerful influence and many people believe their friends and what they read ahead of face-to-face advice from their GP.

This is why the doctor-patient relationship (and continuity of care from a doctor you know, like and trust) is vital. This is why I worry about changes to the GP role, such as no longer providing out-of-hours care, because it undermines that relationship.

I’d like to think I am best placed to weigh up the needs of my patient and plan for her health. This takes time, care and devotion. I have that with her — and even then I failed, as the mythology about statins and mistrust of big drug companies outweighed my influence.

My patient turned out to have very high cholesterol and mild diabetes. Before I said a word, she asked to go back on the statin.

I then discovered she was not taking anti-malarial drugs during business trips to India. How many people die of malaria across the world each year? Two million.